The prognostic value of echocardiographic right ventricular global longitudinal strain in heart failure: A systematic review and meta-analysis

Abstract

Abstract Background Right ventricular (RV) dysfunction is a well-recognized adverse prognostic feature in patients with heart failure (HF). However, accurate RV functional assessment remains challenging in clinical practice. Recently, many studies have demonstrated that RV global longitudinal strain (RV GLS) assessed using speckle tracking echocardiography might be a powerful prognosticator in HF. Aim To systematically appraise and quantitatively synthesize the prognostic evidence of RV GLS derived by echocardiography, across the entire spectrum of left ventricular ejection function (LVEF) in HF. Methods A systemic literature review was conducted in MEDLINE, Scopus and Cochrane databases to identify every study reporting the predictive role of RV GLS in HF subjects irrespective of LVEF. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios [(a)HRs] for all-cause-mortality and the composite outcome of all-cause mortality or any HF-related hospitalization per each unit of increase in RV GLS. Subgroup analysis was feasible for patients with LVEF<45%. Results Thirteen studies were deemed eligible for inclusion in the systematic review. Of them, 8 provided appropriate quantitative data for the meta-analysis, encompassing a total of 3,736 patients. When adjusted for pre-specified clinically-relevant parameters, it was shown that each unit of increase in RV GLS conferred increased risk of all-cause mortality (pooled aHR=1.08 [1.03-1.13]; p<0.01; I²=76%) and the composite outcome (pooled aHR= 1.10 [1.06-1.15]; p<0.01; I²=0%) for patients with HF (Abstract Picture 1 and 2). Subgroup analysis for HF patients with LVEF<45% yielded similar results, with each increase of 1% in RV GLS being independently associated with increased risk of all-cause mortality (pooled aHR=1.10 [1.06-1.13]; p<0.01; I²=0) and the composite end-point (pooled aHR= 1.13 [1.07-1.20]; p<0.01; I²=0%) (Abstract Picture 1 and 2). Conclusion RV GLS assessed by speckle-tracking echocardiography is a novel echocardiographic biomarker that can further add in patient prognostication across a wide range of HF populations regardless of LVEF.RV GLS and all-cause mortalityRV GLS and the composite outcome